Provider Demographics
NPI:1710257969
Name:VERDE VALLEY LLC
Entity Type:Organization
Organization Name:VERDE VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-659-6097
Mailing Address - Street 1:8163 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1121
Mailing Address - Country:US
Mailing Address - Phone:810-659-6097
Mailing Address - Fax:810-659-6120
Practice Address - Street 1:8163 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-1121
Practice Address - Country:US
Practice Address - Phone:810-659-6097
Practice Address - Fax:810-659-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS2503047310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility